As a matter of principal, decisions should be made at the level closest to the problem, by the people who have the most information about the problem and who are most affected by its resolution.
Read the following WSJ op-ed on the government's proposed reform of medical services, and judge for yourself how well it meets the principle above.
Perhaps "reform" aught to be put in "scare quotes," eh?
[To summarize the article; the government proposes reducing health care spending by creating guidelines for what procedures doctors should give to their patients. Originally this included the decision to remove life support from patients, but that was so widely criticized that it had to be withdrawn.]